April 11, 2014

ACP: Physicians have a right and responsibility to discuss gun violence with their patients

A new policy paper from the American College of Physicians (ACP) offers nine strategies to address the societal, health care, and regulatory barriers to reducing firearms-related violence, injuries, and deaths in the United States. Reducing Firearm-Related Injuries and Deaths in the United States is published today in the peer-reviewed medical journal, Annals of Internal Medicine.

Principal among ACP's nine strategic imperatives is the recommendation to approach firearm safety as a public health issue so that policy decisions are based on scientific evidence. As such, ACP strongly supports universal criminal background checks to keep guns out of the hands of felons, persons with mental illnesses that put them at greater risk of harming themselves or others, people with substance use disorders, and others who current regulations prohibit from owning guns.

The United States has the highest firearm-related mortality rate among industrialized nations. ACP believes that a comprehensive, multifaceted approach is necessary to reduce this epidemic of gun violence and that physicians play a vital role.

"Patients have long trusted their physicians to advise them on issues that affect their health," said Molly Cooke, MD, FACP, president of ACP. "Physicians can play a critical role in educating the public on the risks of firearm ownership and the need for firearm safety through their encounters with their patients. ACP strongly believes the patient-physician relationship should be protected from laws that prevent physicians from initiating a discussion about guns."

To inform its policy position, ACP's Health and Public Policy Committee conducted a comprehensive review of the available data on the impact of access to firearms, mental health, state and federal firearms laws, and efforts to reduce firearms violence. ACP also surveyed a large, nationally representative panel of internists in the United States about their attitudes on firearms and firearm injury prevention.

"We concluded that firearm violence is not just a criminal justice issue, but also a public health threat that requires the nation's immediate attention," said Thomas Tape, MD, FACP, chair of ACP's Health and Public Policy Committee. "As an organization representing physicians who have first-hand experience with the devastating impact of firearm-related violence, ACP has a responsibility to participate in efforts to mitigate needless tragedies."

Survey results suggest that ACP's position is supported by internists. Eighty-five percent of internists surveyed believe that firearm injury is a public health issue and 76 percent support stricter gun control legislation. An overwhelming majority of respondents favor mandatory background checks, mandatory registration of all firearms, and bans on assault weapons, high capacity magazines, and armor-piercing bullets. A full report on the physician survey is published today in Annals of Internal Medicine.

Other recommendations in the policy paper include:

ACP supports appropriate regulation on the purchase of legal firearms to reduce firearms-related injuries and deaths, acknowledging that any such regulation must be consistent with the Supreme Court ruling establishing that individual ownership of firearms is a constitutional right under the Second Amendment of the Bill of Rights.

ACP recommends that guns be subject to consumer product regulations regarding access, safety and design. In addition, the College supports law enforcement measures to aid in the identification of weapons used in crimes.

ACP believes that firearm owners should adhere to best practices to reduce the risk of accidental or intentional injuries or deaths from firearms.

ACP cautions against broadly including those with mental illness in a category of dangerous individuals. ACP recommends that every effort be made to reduce the risk of suicide and violence through prevention and treatment of the subset of individuals with mental illness who are at risk of harming themselves or others. ACP believes that diagnosis, access to care and treatment, and appropriate follow up are essential.

ACP believes there is enough evidence to enact legislation banning the sale and manufacture for civilian use of firearms that have features designed to increase their rapid killing capacity (often called "assault weapons" or semi-automatic weapons) and large capacity ammunition and retaining the current ban on automatic weapons for civilian use.

ACP supports efforts to improve and modify firearms to make them as safe as possible, including the incorporation of built-in safety devices.

ACP believes that more research needs to be funded on firearm violence and on intervention and prevention strategies to reduce injuries caused by firearms. Access to data should not be restricted.